The Rationing of a Last-Resort Covid Treatment

Outcomes vary widely among hospitals. Overall, however, survival has decreased over time, including at major U.S. and European hospitals. From January to May of 2020, according to the international registry, less than 40 percent of Covid patients died in the first 90 days after ECMO was started. But in the months after that, more than half died. “The patients seem to be doing markedly worse,” Dr. Barbaro said.

He and his colleagues are analyzing whether that relates to factors like new virus variants, less experienced centers providing care or changes in the treatments patients receive before ECMO.

ECMO is offered in few community hospitals, where most Americans get care. Saint John’s, the Santa Monica facility where the doctor and police sergeant received the treatment, is an exception.

It started an ECMO program about a year before Covid-19 emerged. The 266-bed hospital has provided the therapy to 52 Covid patients during the pandemic, about the same as the entire Northwell health system in New York, which has more than 6,000 hospital and long-term-care beds.

The Saint John’s charitable foundation, supported by the area’s wealthy donor base, helped fund the ECMO program and its expansion. The hospital accepted some uninsured Covid patients for ECMO, whereas elsewhere these patients were often turned down despite a federal program that reimburses hospitals for their care.

“There are just so many inequities,” said Dr. Hammond, Saint John’s I.C.U. director. And for every Covid patient who survived with ECMO, there are “probably three, four, five people that die on the waiting list.”

She and other doctors said the pandemic highlighted the need for ECMO to be made more widely available and less resource intensive. Until then, “we really need to have a system for sharing,” she said. Allocation systems do exist for transplant organs and trauma care.

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